Healthcare Provider Details

I. General information

NPI: 1518033554
Provider Name (Legal Business Name): SOUTH SOUND WOMEN'S CENTER LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 CAPITAL MALL DR SW SUITE 400
OLYMPIA WA
98502
US

IV. Provider business mailing address

3920 CAPITAL MALL DR SW SUITE 400
OLYMPIA WA
98502
US

V. Phone/Fax

Practice location:
  • Phone: 360-705-1259
  • Fax: 360-705-2757
Mailing address:
  • Phone: 360-705-1259
  • Fax: 360-705-2757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD N HENEGAN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 360-705-1259